Peanut drops under the tongue for allergic children over four years
What it found
Most peanut-allergic children aged 1 to 11 could eat much more peanut after taking daily peanut drops under the tongue for 48 months.
Protection lasted weeks after stopping, and no doses needed epinephrine.
What they found
Studies in people
Tolerating more peanut protein
After 48 months, the average amount of peanut protein children could eat without symptoms rose from 48 mg to 2723 mg. About 70% reached at least 800 mg, and 36% ate the full 5000 mg test dose without symptoms.
Protection after stopping treatment
When children stopped taking the drops, the modeled median time before they lost their improved tolerance was 22 weeks. None of the 37 children tested reacted to less than 300 mg during the 17-week break.
Side effects at home
Symptoms happened with 4.0% of home doses, mostly temporary itching in the mouth or throat. No dosing symptoms required epinephrine, and three children left the study because of stomach problems.
Changes in allergy tests
Skin prick test swelling dropped from 16.5 mm to 9.1 mm by the end of treatment. Blood markers linked to allergy also shifted, including a fall in peanut-specific IgE from 213.0 kU A /L to 60.7 kU A /L.
What the authors conclude
- They conclude that daily peanut drops under the tongue helped most children in the study tolerate much more peanut protein after 48 months.
- They note that this protection lasted for weeks even when children stopped taking the drops, which could help guard against accidental exposures.
- The authors suggest that the balance of results and side effects makes this approach a promising option for treating peanut allergy in children.
How it was done
Peanut allergy rarely goes away on its own and can cause severe reactions. The authors wanted to see if a higher daily dose of peanut drops placed under the tongue could help children tolerate more peanut and how long that protection would last after stopping treatment.
Fifty-four children with confirmed peanut allergy, aged 1 to 11, took 4 mg of peanut protein under the tongue every day for 48 months. After that, those who improved were randomly told to stop the drops for 1 to 17 weeks before a final food challenge to see if protection remained.
What it can’t tell you
- Because everyone knew they were getting the real treatment, some improvement might be due to expectation rather than the drops alone.
- Children with the most severe past reactions or severe asthma were not included, so the results may not apply to them.
- Up to 20% of children might outgrow peanut allergy naturally, though the authors think this was unlikely in their group.
Who paid
- Funding
- Funded by NIAID NIH HHS; NCATS NIH HHS; NCI NIH HHS; NCCIH NIH HHS (from the PubMed record).
- Conflicts
- Conflicts of interest: EHK reports scientific advisory board membership with ALK-Abello, DBV Technologies, Kenota Health and Ukko Inc; consultancy for AllerGenis, Allergy Therapeutics Ltd, Belhaven Pharma, Duke Clinical Research Institute, Genentech, and Nutricia; and receives grant support to his institution from the NIH-NIAID and FARE. CAK is an Associate Editor at JACI, is on the Board of the American Board of Allergy and Immunology, and receives royalties from UpToDate. MDK reports consultancy for Ukko, Inc and receives grant support to his institution from the NIH and DoD. AWB reports being a minority stock holder in Allertein and Mastcell Pharmaceuticals; scientific advisory board membership with Aimmune Therapeutics, Consortia TX and Prota Therapeutics; consultancy for ALK-Abello, Astellas Pharma, DBV Technologies, N-Fold LLC, Kaleo, Ukko Inc; royalties with UpToDate; and receives grant support to his institution from the NIH-NIAID, NIH-NCCIH, and FARE. The rest of the authors declare that they have no relevant conflicts of interest.
- Authors work at
- University of North Carolina School of Medicine, NC; Center for Drug Evaluation and Research, Md; University of North Carolina at Chapel Hill, NC
The paper
- Title
- Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children
- Type
- Randomised controlled trial
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Kim EH, Keet CA, Virkud YV, et al (2023). Open-label study of the efficacy, safety, and durability of peanut sublingual immunotherapy in peanut-allergic children. The Journal of allergy and clinical immunology. doi:10.1016/j.jaci.2023.01.036Free full textPubMed 36828080DOI
Summary written 30 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error